The will to change

Defusing that time bomb in your chest is entirely up to you

February 10, 2002|By Bob Condor, Tribune staff writer.

The numbers don't lie: About 62 million Americans have cardiovascular disease. Nearly a million die from heart troubles each year, including 250,000 who don't make it alive to the hospital after cardiac arrest. Bypass surgeries and angioplasty procedures are up some 300 percent in the last 10 years.

But these numbers don't seem to carry much influence with people, even when the push is on in February, American Heart Month. Changing health habits to protect against heart disease is a tough sell for doctors and public health officials alike.

It's even hard to persuade individuals who have survived a first heart attack or bypass surgery. Thirty percent to 40 percent have recurrences. Getting through to people with known risk factors but no actual symptoms is a daunting task.

"Most people think prevention is boring," said Dr. Dean Ornish, the physician and author who has published many head-turning, peer-reviewed journal studies about reversing heart disease without drugs. "I say reframe it for people. It's not about living longer but living better."

Ornish said the interventions of nutrition, physical activity, relaxation exercises and social support used at his Preventive Medicine Research Center in Sausalito, Calif., all contribute to a healthier heart-and mind-set.

"The brain gets more blood," he said. "We think more clearly."

Although not everyone accepts Ornish's premise that an extremely low-fat vegetarian diet is an integral choice for reversing or preventing heart disease, other experts agree on the need to find innovative ways to communicate the heart-disease prevention message. There are enough expert approaches to fit anyone's lifestyle.

"We don't just tell people they need to be more physically active," said Nicole DeVantier, a cardiac-rehabilitation nurse and exercise physiologist at Swedish Covenant Hospital on Chicago's Northwest Side. "We teach them the heart is a muscle and explain the theory of how all of their muscles will respond to exercise.

"We educate them about what's called the `perceived rate of exertion.' They learn how to become aware of their body's capability, that breathing hard is a normal part of exercise and doesn't necessarily mean you have shortness of breath."

The good news in all of this heart-to-heart talk is that small changes in lifestyle can produce significant results. The not-so-good news is that more of us may be vulnerable, because researchers are establishing risk factors beyond the usual lineup of high cholesterol, high blood pressure, diabetes, smoking, obesity and family history.

There now is considerable evidence that psychosocial factors, including stress, depression, social isolation and hostile personality traits, can become tangible risk factors depending on how an individual handles it. There is growing opinion that metabolic syndrome, or Syndrome X, associated with the body's inability to process insulin, might be responsible for as many as half of all heart attacks. Other studies suggest that being more optimistic can enhance heart health, while bacterial infections (the mouth and gums included) can increase cardiovascular risk.

Just how the good and bad news balances is up to you.

"We tell patients with known risk factors they are more likely to get better if they make changes," said Dr. Robert Rosenson, director of preventive cardiology research at Northwestern University Medical School. "Or that they are more likely to get worse if they ignore the risk factors."

Some risk factors for heart disease are unavoidable, such as growing older (four of five people who die of coronary disease are 65 or older), being male (men have greater risk of heart attacks, especially earlier in life), family history (children of parents who suffered heart attacks are statistically more likely to develop coronary disease) and heredity (heart problems are more common among African-Americans, Mexican-Americans, Native Americans, native Hawaiians and some Asian-American groups compared with white individuals. But other risk factors can be minimized with the right lifestyle changes.

Cigarette smoking is the leading risk factor for sudden death from heart attacks. Smokers are twice as likely to suffer a heart attack compared with non-smokers. The newest research shows that people who live with smokers or are significantly exposed to secondhand smoke are at heightened risk compared with non-smokers.

Excess weight is another high predictor of heart disease. People with excess body fat, especially if accumulated around the waist, are more likely to develop heart disease even if they have no other risk factors.